Stay on top of your health with doctor visits, prescriptions, vaccines and free preventive care. Our CalOptima Health Covered plan options offer affordable coverage, a trusted local network, and care that meets your health needs.
Choose from 4 metal tier plans: Bronze, Silver, Gold, and Platinum. Each offers different premiums and out-of-pocket costs to match your needs.
Bronze 60
Silver 70
Silver 73
Silver 87
Silver 94
Gold 80
Platinum 90
Medical Deductible
$5,800 individual / $11,600 family
Out-of-Pocket Max (individual)
$11,650 individual / $23,300 family
Primary Care Visit
$60 copay
Specialist Visit
$100 copay (Deductible applies after 1st three non-preventive visits)
Generic Prescription Drugs (Tier 1)
$20 copay
Medical Deductible
Silver 70: $4,700 individual / $9,400 family
Silver 73: $4,700 individual / $9,400 family
Silver 87: $1,100 individual / $2,200 family
Silver 94: $200 individual / $400 family
Out-of-Pocket Max (individual)
Silver 70: $11,650 individual / $23,300 family
Silver 73: $9,600 individual / $19,200 family
Silver 87: $4,000 individual / $8,000 family
Silver 94: $3,000 individual / $6,000 family
Primary Care Visit
Silver 70: $50 copay
Silver 73: $50 copay
Silver 87: $15 copay
Silver 94: $5 copay
Specialist Visit
Silver 70: $100 copay
Silver 73: $100 copay
Silver 87: $30 copay
Silver 94: $8 copay
Generic Prescription Drugs (Tier 1)
Silver 70: $20 copay
Silver 73: $20 copay
Silver 87: $10 copay
Silver 94: $3 copay
Silver is the ONLY tier where Cost-Sharing Reductions (CSR) apply. Members at 138–250% FPL may access Silver 73, 87 or 94 — dramatically lowering deductibles and copays.
Deductible
$0 individual / $0 family
Out-of-Pocket Max (individual)
$9,600 individual / $19,200 family
Primary Care Visit
$40 copay
Specialist Visit
$80 copay
Generic Prescription Drugs (Tier 1)
$19 copay
Deductible
$0 individual / $0 family
Out-of-Pocket Max (individual)
$5,500 individual / $11,000 family
Primary Care Visit
$20 copay
Specialist Visit
$45 copay
Generic Prescription Drugs (Tier 1)
$10 copay
Cost-sharing amounts reflect standardized 2026 Covered California benefit designs. Confirm CalOptima Health plan-specific figures in your Summary of Benefits and Coverage (SBC).
Deductible
$12,000 individual / $24,000 family
Out-of-Pocket Max (individual)
$12,000 individual / $24,000 family
Primary Care Visit
0% (Deductible applies after 1st three non-preventive visits)
Specialist Visit
0% (After deductible)
Generic Prescription Drugs (Tier 1)
0% (After deductible)
Eligibility for Minimum Coverage (Catastrophic) Plans
Search our network to find a trusted provider that meets your health care needs.
Need help enrolling or have questions? Call CalOptima Health Covered Customer Service toll-free at 1-888-312-2221 (TTY 711), Monday‒Friday, from 8 a.m. to 6 p.m. We have staff who speak your language.
See the benefits and services our CalOptima Health Covered plan offers.
View our list of covered drugs (formulary) and find a participating pharmacy near you.